ppt

1. STOMACH
Dr.Kumar Satish Ravi
M.B.B.S.,M.D.(JIPMER), MAMS

2. Location
 Upper and left part of abdomen
 Epigastric, umbilical and left
hypochondrial region

3. Stomach
 In adult life, stomach located T10 and
L3 vertebral segment
 Can be divided into anatomic regions
based on external landmarks
 4 regions
 Cardia
 Fundus
 Corpus (body)
 Antrum

5. Anatomy
 Cardia- region
just distal to the
GE junction
 Fundus- portion
above and to the
left of the GE
junction

6. Anatomy
 Corpus- region
between fundus and
antrum
 Margin not distinctly
external, has arbitrary
borders
 Antrum- bounded
distally by the
pylorus
 Which can be
appreciated by
palpation of a
thickened ring of
smooth muscle

7. shape
 Depends on degree of distension and
surrounding viscera
 Empty - J shape
 Partly distended - piriform
 Obese - horizontal - steer horn
stomach

8. size
 Distensible
 10 in. long
Capacity
 30 ml - birth
 1 l - puberty
 1 ½ l – 2 l or more - adult

9. External features
 Cardiac orfice -7th costal cartilage, T 11
vertebra
 Pyloric orifice - lowerborder of L 1
Pyloric constriction - circular groove
Pylorus = gate guard
PrePyloric vein in front of constriction
 Lesser curvature, lesser omentum, incisura
angularis

10. External features…
 Greater curvature, GO,GS,GP.
 cardiac notch
Anterior surface - forward upward
Posterior surface -backward downward

11. Sub divisions
 Cardiac ,Pyloric parts
Cardiac – fundus , body
Pyloric – pyloric antrum ( 3 in.), pyloric
canal(1 in.)

12. Relations
Peritoneal
 Lesser omentum
 Greater omentum
 Gastrosplenic ligament
 Gastrophrenic ligament
 Bare area

13. Relations…..
Visceral
 Anterior surface
Liver, diaphragm, ant. Abd.wall
 Posterior surface
Diaphragm, Lt. kidney, Lt. supra renal
gland, pancreas, transverse mesocolon,
splEnic flexure of colon, splenic artery -
stomach bed

14. Sromach Bed

15. Interior of stomach
 Gastric rugae
Longitudinal along lesser curvature –
gastric canal, irregular elsewhere.
 Gastric pits
Gastric glands opens

16. Vasculature
 Well vascularized organ
 Arterial flow mainly derived from
Celiac Artery
 3 Branches
Left Gastric Artery
Supplies the cardia of the
stomach and distal esophagus

17. Splenic Artery
Gives rise to 2 branches which
help supply the greater
curvature of the stomach
Left Gastroepiploic
Short Gastric Arteries

18. Common Hepatic or Proper Hepatic
Artery
2 major branches
Right Gastric- supples a
portion of the lesser curvature
Gastroduodenal artery
-Gives rise to Right
Gastroepiploic artery
-helps supply
greater curvature in
conjunction with Left
Gastroepiploic Artery

19. Blood supply
 Left gastric artery- br of coeliac trunk
 Right gastric artery- br of common
hepatic artery
 Right gastro epiploic artery- br of
gastrodoudinal artery
 Left gastro epiploic artery- br of
splenic artey
 5-7 short gastric arteries -br of
splenic artery

20. Arterial Supply

21. Vasculature

22. Blood supply
Veins
Portal vein
Superior mesenteric vein
Splenic vein

23. Venous drainage
• Right & left gastric veins -> hepatic
portal vein.
 Left gastroepiploic & short gastric
veins -> hepatic portal vein via the
splenic vein.
 Right gastroepiploic vein join superior
mesenteric vein.

24. Venous Drainage

25. Lymphatic drainage
 Area A pancreatosplenic
 Area B left gastric
 Area C right gastroepiploic sub pyloric
hepatic
 Area D diff directions into pyloric,
hepatic, left gastric
 Coeliac trunk cisterna chyli

26. Lymphatic Drainage

27. Anatomy
 Lymphatic drainage
 Lymph from the proximal portion of the
stomach drains along the lesser curvature first
drains into superior gastric lymph nodes
surrounding the Left Gastric Artery
 Distal portion of lesser curvature drains
through the suprapyloric nodes
 Proximal portion of the greater curvature is
supplied by the lymphatic vessels that traverse
the pancreaticosplenic nodes
 Antral portion of the greater curvature drains
into the subpyloric and omental nodal groups

28. Anatomy
 Nerve Supply
 Left and Right Vagus Nerves descend
parallel to the esophagus within the
thorax before forming a peri-esophageal
plexus between the tracheal bifurcation
and the diaphragm
 From this plexus, two vagal trunks
coalesce before passing through the
esophageal hiatus of the diaphragm

29. Anatomy
 Left (anterior)
Vagus Nerve
 Left of the
esophagus
 Branches
 Hepatic Branch
 Supplies liver
and Biliary
Tract
 Anterior gastric
or Ant. Nerve of
Latarget


30. Anatomy
 Right (posterior)
Vagus Nerve
 Right of the
esophagus
 Branches
 Celiac
 Posterior
Latarget
 Innervates
posterior
gastric wall

31. Anatomy
 Parasympathetic innervation of
Stomach- Vagus Nerve
 90% of fiber in vagal trunk is afferent
(info transmitting from stomach to CNS)
 Sympathetic innervation of Stomach-
Splanchnic Nerve
 Derived from spinal segement T5-T10

32. Nerve supply
 Sympathetic T5 - T10
Via splanchenic nerves, coeliac and
hepatic pluxes
 Vasomotor
 Motor to pyloric shincter only
 Pain sensation from stomach

33. Nerve supply
 Parasympathetic
From vagi through oesophageal pluxes
and gastric nerves
 Motor and secretomotor

34. Innervation

35. functions
 Reservoir of food
 Peristaltic movements
 Gastric glands gastric juice, HCL
 Mucous
 absorption

36. Applied anatomy
 Displacement of stomach
 Hiatus hernia
 Congenital diaphramatic hernia
 Pyloro spasm
 Congenital hypertrophic pyloric stenosis
 Gastrectomy – ca stomach

37. Applied anatomy
 Ulcers, helico bacter pylori and
vagotomy
 Gastric pain felt in epigastium
 Barium meal x ray, gastroscope

38. THANK YOU